ASVMEB Order 22057 RYAN BUNCE, DVM

BEFORE THE ARIZONA STATE VETERINARY MEDICAL
EXAMINING BOARD
IN THE MATTER OF: CASE NOo.: 22-57

RYAN BUNCE, DVM
HOLDER OF LICENSE No. 7393

FINDINGS OF FACT,
CONCLUSIONS OF LAW
AND ORDER

FOR THE PRACTICE OF VETERINARY
MEDICINE IN THE STATE OF ARIZONA,

Veyeveveve Veer

RESPONDENT.

The Arizona State Veterinary Medical Examining Board (“Board”)
considered this matter at its public meeting on June 15, 2022. Ryan Bunce, DVM
(“Respondent") appeared on his own behalf for an Informal Interview that was
held pursuant to the authority vested in the Board by A.R.S. § 32-2234(A}. After
due consideration of the evidence, the arguments and the applicable law, the
Board voted to issue the following Findings of Fact, Conclusions of Law and
Order (“Order”).

FINDINGS OF FACT

]. Respondent is the holder of License No. 7393 and is therefore authorized
to practice the profession of veterinary medicine in the State of Arizona.

2. On October 21, 2021, at approximately 5:00pm, “Ginger,” an 11-year-old
female Corgi was presented to Respondent due to a swollen, bloody left eye. It
was suspected that she had been scratched by a cat. The dog was triaged by
technical staff; weight = 32. 4 pounds, temperature = 102.1 degrees, pulse rate
= 160bpm, and a respiration rate = 100rpm/panting. Complainants reported
that the dog would bite, which she attempted to when staff reached to auscult

the dog's heart. Staff requested analgesia for the dog; therefore, Respondent's

22-57, Ryan Bunce, DVM

a

13

14

associate Dr. Butler evaluated the dog and ordered an injection of
buprenorphine 0.3mg/mL, 0.22mL IV. The dog was placed in a kennel until she
could be seen. Complainants elected to leave the dog and completed a
drop-off form.

3. At 7:00pm, Respondent started his shift. After finishing rounds, he
evaluated the dog around 8:30pm. The dog had an Elizabethan collar on and
was panting, she did not respond when Respondent opened the kennel. He
noted blepharospasm of the left eye with moderate chemosis and mild
subconjunctival hemorrhage. The globes appeared normal, the dog was visual
and positive menace response was present bilaterally. The dog had significant
extrathoracic fat - BCS 8-9/9 ~ therefore her heart and lung sound were
muffled. Respondent attempted to palpate the dog's abdomen when the dog
turned to bite despite being administered an analgesic earlier.

4, Respondent contacted Complainants to advise’ that the dog attempted
to bite, therefore, recommended sedation for diagnostics; Complainants
approved. Respondent also discussed the abnormalities noted thus far with the
left eye. He stated that cat scratches are common but can be severe and
difficult to treat. Risks of sedation were discussed as well as the costs associated
with the services — Complainants electronically signed for approval and
elected DNR.

5. Respondent examined the dog again prior to sedation and the dog was
administered midazolam 1.5mg IV and dexmedetomidine 15mcg IV. Oxygen
was provided via mask and the dog was monitored while under sedation.

Blood was collected for testing.

22-57, Ryan Bunce, DVM

Nn

24

25

6. Respondent noted that the intraocular pressures were normal and tear
production was appropriate. The eyes were stained and revealed a focal,
superficial uptake of stain in the left eye consistent with a corneal ulcer. A deep
assessment of the conjunctiva was impossible due to the extent of chemosis -
decreased retropulsion of the left eye was noted. Respondent stated that he
did not identify any lacerations/wounds, foreign material, or irregularities of the
globe or anterior chamber. After evaluation, the dog's sedative was reversed
with antisedan. Respondent relayed that the dog's recovery was slow, but vital
signs returned to what they were prior to sedation. The dog continued panting
but with a more depressed mentation and wide-eyed, dysphoric appearance.

7. Respondent called Complainants to let them know his findings. He
explained there was no evidence of trauma or foreign material, but the
periocular swelling made the tissue difficult to evaluate thoroughly. He went
over the blood results, explained that enucleation may be indicated if the dog
continued to be in pain, and recommended a follow up exam and/or referral
to an ophthalmologist. The dog was being discharged with the following:

a. NeoPolyBac Ophthalmic Ointment; apply to left eye every 6 - 8

hours;
b. Eye lubricant; apply to left eye as needed;
Cc. Carprofen 25mg; 1 tablet orally twice a day; and

d. Gabapentin 200mg; 1 tablet orally once - twice daily.
8. At 11:30pm, Complainants arrived to pick up the dog. The dog would not
walk; therefore, was carried into the exam room by technical staff. According
to Complainants, not only could the dog not walk, she was hyperventilating.

They insisted to speak to Respondent — when asked about the dog's breathing,

22-57, Ryan Bunce, DVM

w

he responded that the dog was in that condition when he initially evaluated
her. Complainants were adamant that the dog was nof hypervenitilating when
presented.

9, According to Respondent, he spoke to Complainants upon their request.
They expressed concern about the swelling of the dog's eye and requested a
steroid instead of an NSAID. Respondent expressed his concern with the
potential adverse effects of steroids and explained that if the dog's eye
became proptosed, enucleation may be required. While speaking with
Complainants, Respondent noted the dog was still panting heavily and did not
respond when he entered the room. He examined the dog and noted she was
responsive but sedate. Respondent advised that he believed the dog's
appearance and mentation was likely the result of the pain and anti-anxiety
medications. He recommended monitoring the dog closely and to call if there
were further concerns.

10. According to Complainants, they were not provided with discharged
instructions when they left the premises. They were also concerned that no
treatment was provided to the dog while at the premises.

11. An hour after arriving home, the dog passed away.

12. The Board concluded that Respondent's conduct fell below the
standard of care by failing to recognize, and address, the distress that the dog
was exhibiting at discharge; he should have offered continued monitoring;
explain the dog's diagnosis fo the pet owner; relay that other maladies were
possibly occurring that he could not identify; and sent the dog home in an

unstable/unknown condition.

22-57, Ryan Bunce, DVM

ab

CONCLUSIONS OF LAW
13. The conduct and circumstances described in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (12) as it relates to A.A.C. R3-11-501
(1) failure to provide professionally acceptable procedures by not fully
explaining the dog's diagnosis to the pet owners; that there could be other
maladies occurring that were not identified and sending the dog home in an

unstable/unknown condition,

ORDER

Based upon the foregoing Findings of Fact and Conclusions of Law it is
ORDERED that Respondent's License, No. 7393 be placed on PROBATION for a
period of one (1) year, subject to the following terms and conditions that shall
be completed within the Probationary period. These requirements include four
{4} total hours of continuing education (CE) detailed below:

1. IT IS ORDERED THAT Respondent shall provide written proof satisfactory to
the Board that he has completed four (4) hours of continuing education (CE);
hours earned in compliance with this order shall not be used for licensure
renewal. Respondent shall satisfy these four (4) hours by attending CE in the
area of emergency ophthalmology. Respondent shall submit written verification
of attendance to the Board for approval prior to the end of the Probationary
period.

2. All continuing education to be completed for this Order shall be pre-
approved by the Board. Respondent shall submit fo the Board a written outline
regarding how he plans to satisfy the requirements in paragraph 1 for its

approval within sixty (60) days of the effective date of this Order. The outline

22-57, Ryan Bunce, DVM

ow

shall include CE course details including, name, provider, date(s), hours of CE to
be earned, and a brief course summary.

3. Respondent shall obey all federal, state and local laws/rules governing
the practice of veterinary medicine in this state.

4, Respondent shall bear all costs of complying with this Order.

5. This Order is conclusive evidence of the matters described and may be
considered by the Board in determining an appropriate sanction in the event a
subsequent violation occurs. In the event Respondent violates any term of this
Order, the Board may, after opportunity for Informal Interview or Formal
Hearing, take any other appropriate disciplinary action authorized by law,
including suspension or revocation of Respondent's license.

NOTICE OF APPEAL RIGHTS

Respondent is hereby notified that he has the right to request a rehearing
or review of the Order by filing a motion with the Board’s Executive Director
within 30 days after service of this Order. Service of the Order is effective five
days after the date of mailing to Respondent. See A.R.S. § 41-1092.09. The
motion must set forth legally sufficient reasons for granting a rehearing or
review. A.A.C. R3-11-904. If a motion for rehearing or review is not filed, the
Board's Order becomes final 35 days after if is mailed to Respondent.
Respondent is further notified that failure to file a motion for rehearing or review
has the effect of prohibiting judicial review of the Order, according to A.R.S. §
41-1092.09(B) and A.R.S. § 12-904, et seq.

Dated this_ /* day of Leeguat 2022.

Arizona State Veterinary Medical Examining Board
Jessica Creager
Chairperson

22-57, Ryan Bunce, DVM

an

24

25

By:

Victori hitmore, Executive Director

Original of the foregoing filed this oa day of Auguct, 2022
with the:

Arizona State Veterinary
Medical Examining Board
1740 W. Adams St., Ste. 4600
Phoenix, Arizona 85007

Copy of the foregoing sent by certified, return receipt mail

this /%_ day of hegrad- , 2022 to:

Ryan Bunce, DVM
Address on file
Respondent

Board Staff

22-57, Ryan Bunce, DVM

4